Utilization Review Nurse Specialist

Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Children's Healthcare of Atlanta. As a key member of our multidisciplinary team, you will play a critical role in ensuring the efficient and effective delivery of healthcare services to our patients.ResponsibilitiesParticipate in pre-screening assessments of prospective patients...

Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Children's Healthcare of Atlanta. As a key member of our multidisciplinary team, you will play a critical role in ensuring the efficient and effective delivery of healthcare services to our patients.ResponsibilitiesParticipate in pre-screening assessments of prospective patients...

Job Description:The Utilization Review Nurse role at Sonder Health Plans is a critical position that ensures healthcare services are administered with quality, cost efficiency, and within compliance.Key Responsibilities:Conduct concurrent reviews of members' clinical information to ensure efficiency and effectiveness of care.Review preauthorization requests...

Job Title: Utilization Review NurseAt Sonder Health Plans, we are seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that healthcare services are administered with quality, cost efficiency, and within compliance.Key Responsibilities:Conduct concurrent reviews of member...

Job Description:The Clinical Review Specialist role at Sonder Health Plans is to ensure that healthcare services are administered with quality, cost efficiency, and within compliance.By continuously reviewing and auditing member treatment records, the Clinical Review Specialist will ensure members do not receive unnecessary procedures, ineffective treatment,...

Job Summary:We are seeking a skilled RN Inpatient Utilization Reviewer to join our team at Health eCareers. As a key member of our healthcare team, you will be responsible for carrying out utilization review, quality review, and discharge planning for inpatient admissions at facilities without QRM review staff onsite.Key Responsibilities:Conduct telephonic...

About the RoleAs a Utilization Review Nurse at Sidecar Health, you will play a critical role in evaluating the medical necessity and quality of healthcare services for our members. This involves reviewing medical records, ensuring compliance with established clinical guidelines and policies, and collaborating with healthcare providers to gather additional...

Job Summary:Piedmont is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed reviews of patient medical...

Job SummaryPiedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key ResponsibilitiesConduct detailed reviews of...

About the Role:Piedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed...

Job Description:The Clinical Review Specialist role at Sonder Health Plans is to ensure that healthcare services are administered with quality, cost efficiency, and within compliance.By continuously reviewing and auditing member treatment records, the Clinical Review Specialist will ensure members do not receive unnecessary procedures, ineffective treatment,...

Job Title: HEDIS Nurse Abstractor SpecialistJob Summary:Spectraforce Technologies is seeking a highly skilled HEDIS Nurse Abstractor Specialist to join our team. As a HEDIS Nurse Abstractor Specialist, you will be responsible for reviewing medical records, abstracting pertinent data, and entering it into a specified database to support HEDIS reporting.Key...

Job Title: Subsurface Utility Engineering SpecialistAre you interested in a career that combines technical skills with outdoor work? T2 Utility Engineers, Inc. is seeking a skilled Subsurface Utility Engineering Specialist to join our team in Norcross, GA.Job Summary:We are looking for a highly motivated and detail-oriented individual to assist our team in...

Job SummaryZelis is seeking a skilled Nurse Reviewer I to join our team. As a key member of our healthcare financial experience team, you will play a critical role in modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers.Key...

Job SummaryZelis is seeking a skilled Nurse Reviewer I to join our team. As a key member of our healthcare financial experience team, you will play a critical role in modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers.Key...

Job Title: Utilization Management NurseAbout the Role:Sonder Health Plans is seeking a highly skilled Utilization Management Nurse to join our team. As a key member of our clinical operations team, you will play a critical role in ensuring the efficient and effective administration of our health services.Key Responsibilities:Determine the appropriateness of...

Job Title: Quality Assurance Nurse ReviewerJob Description:The Quality Assurance Nurse Reviewer will work under the direction of the HEDIS Quality Assurance Team Lead and other company personnel to perform quality assurance reviews on medical records.The candidate will validate abstracted medical record data and enter findings electronically into a specified...

Job SummaryEmory Healthcare is seeking a skilled Critical Care Nurse to fill the role of Resource Utilization Specialist. This position is responsible for supporting the critical care units in providing a consistent level of care by assisting with patients leaving the ICU for diagnostic testing or procedures, assuming a direct patient care assignment as...

About the RoleUnitedHealth Group is seeking a highly skilled and experienced Radiation Oncology Nurse Specialist to join our team. As a Telephonic Oncology Review Nurse, you will play a critical role in ensuring the delivery of high-quality patient care by performing pre-service clinical coverage reviews of services that require notification.Key...

Job SummaryEmory Healthcare is seeking a skilled Critical Care Nurse to join our team as a Resource Utilization Specialist. This role is responsible for supporting the critical care units in providing a consistent level of care by assisting with patients leaving the ICU for diagnostic testing or procedures, assuming a direct patient care assignment as needed...